AB1081 FLARES OF RHEUMATOID ARTHRITIS FOLLOWING CORONAVIRUS VACCINATION
Authors: R. Hayward, Z. Farah
Journal: Annals of the Rheumatic Diseases (2022)

Background With the emergence of the Coronavirus vaccine and the clear and important role it provides in maintaining the health of individuals and the population (1), it is important that our patients receive or are recommended the vaccine. We here document a case series of patients who have long-term quiescent rheumatoid arthritis who then experienced a flare of disease activity after receiving a vaccine. This information is important to understand as it allows informed discussions regarding the side effect profile of the vaccine and also the influence this may have on the patient’s disease control and future management options. Objectives To understand the changes to control of rheumatoid arthritis in those experiencing a flare of disease after receiving the coronavirus vaccine. Methods Patients were reviewed in clinic as part of standard care. Individuals with Rheumatoid Arthritis who had experienced a flare defined as a self-reported disease activity score of &gt;5.1 in otherwise stable disease were noted and their response to treatment reviewed. This was a review of usual clinical practice and did not alter the treatment undertaken or monitoring of the patent. Information obtained was through the consultation with a rheumatologist and the data was collected retrospectively through review of clinical notes and clinic letters. Results The table below outlines the patient details and treatment responses. All flares occurred within two weeks of receiving the vaccine. Of the patients who flared, two required short term steroid treatment; three an increase in the usual medications and one who had been in disease remission to re-start previous therapy. More patients in the Pfizer vaccine group required an escalation of usual care compared to the AstraZeneca vaccine group. Table 1 Antibody status Vaccine brand Time since diagnosis Time since last flare Flare after 1 st or 2 nd dose Usual treatment Flare management Seropositive, anti-CCP positive AstraZeneca 13 years 3 years 1 st Etanercept, Methotrexate Intramuscular Methylprednisolone Seropositive, anti-CCP positive AstraZeneca 11 years 4 years 1 st Etanercept, Sulfasalazine Intramuscular Methylprednisolone, local joint injection Seronegative, anti-CCP negative AstraZenica 13 years 2 years 1st Methotrexate Increase methotrexate dose Seronegative, anti-CCP positive Pfizer 23 years 11 years 1 st Infliximab Local joint injection, reduce interval of infusions Seronegative, anti-CCP positive Pfizer 7 years 3 years 2 nd Sulfasalazine, hydroxychloroquine Increase Sulfasalazine dose Seropositive, anti-CCP positive Pfizer 7 years 4 years 2 nd nil Re-start methotrexate, hydroxychloroquine Conclusion We report 6 cases of rheumatoid arthritis flare soon after receipt of the coronavirus vaccine. In all, disease control was returned with minimal changes to treatment, 42% of those requiring either no treatment or an intramuscular steroid injection alone. Therefore, we recommend that clinicians should counsel patients of this potential effect, but continue to advocate the vaccine, as the risk of complications to their underlying arthritis is very low and seemingly easily treatable. References [1]Tenforde MW, Olson SM, Self WH, Talbot HK, Lindsell CJ, Steingrub JS, et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years - United States, January-March 2021. MMWR. Morbidity and mortality weekly report. 2021; 70 (18): 674-679. Available from: doi: 10.15585/mmwr.mm7018e1 Disclosure of Interests None declared